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Somebody's Watching You!

Published on 

Friday, October 26, 2012

How many times have you heard someone say that complete and accurate medical record documentation and quality improvement efforts are vitally important because they impact what is being publically reported about your hospital? Well, it’s true. But who exactly is looking at you?

The Centers for Medicare and Medicaid Services (CMS) has provided an educational tool for hospitals titled Contractor Entities At A Glance: Who May Contact You About Specific Centers for Medicare & Medicaid Services (CMS)

  • Program Integrity Contractors (i.e. Recovery Auditors, Zone Program Integrity Contractors (ZPICs), Comprehensive Error Rate Testing Review Contractor (CERT RC) and Medicaid Integrity Contractors (MICs)),
  • Quality Contractors (i.e. Quality Improvement Organizations (QIOs)),
  • Specialized Work Contractors (i.e. Medicare Coordination of Benefits Contractor (COBC)),
  • Claims Administrative Contractors (i.e. MACs, DME MACs); and
  • Appeals Contractors and Entities (i.e. Qualified Independent Contractors (QIC) and Administrative Law Judge (ALJ).

While this is a great tool for hospitals to understand who may contact them, what sources are available for the public to use to select a physician, a hospital, a nursing home, etc.?

In June of 2011 the Robert Wood Johnson Foundation launched a

National Directory that is a compilation of state, federal, hospital and health plan quality data from across the country. The Foundation indicates that “our directory provides access to publicly available, free reports with information about the process of delivery care (for example, did patients get all the recommended care?), actual outcome for patients (for example, did patients die or have to return to the hospital?), what patients said in surveys about their experience with physicians or hospitals, and/or cost.” In the 16 months since the Directory was launched the list of public reports has increased from 224 separate sites to 258.

Below is a much smaller list of sites compiled by MMP, Inc. to provide you with an idea of who is publicly reporting data about your hospital and information about each report.


About the Reports

Link to Website

Consumer Reports

"Our hospital Ratings help you compare hospitals based on our patient safety score, as well as individual measures relating to patient experience, patient outcomes, and certain hospital practices."

Dartmouth Atlas

"For more than 20 years, the Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide information and analysis about national, regional, and local markets, as well as hospitals and their affiliated physicians. This research has helped policy makers, the media, health care analysts and other improve their understanding of our health system and forms the foundation for many of the ongoing efforts to improve health and health systems across America.


"More than 200 million consumers use Healthgrades websites to find, compare, select, and connect with a doctor or hospital, and use is comprehensive information about clinical outcomes, patient satisfaction, patient safety, and health conditions to make more informed healthcare decisions."

Hospital Compare

"Hospital Compare has information about the quality of care at over 4,000 Medicare-certified hospitals across the country. You can use Hospital Compare to find hospitals and compare quality of their care."

Physician Compare

Enables you to find physicians and healthcare professionals that are enrolled in Medicare, their Education, Specialty, gender, hospital affiliation, address and phone number by location, if they speak languages other than English and if they accept Medicare Assignment.

In addition to Hospital and Physician Compare, you can access Nursing Home Compare, Home Health Compare and Dialysis Facility Compare to assist in selecting post-acute care services.

Joint Commission

"The Joint Commission's Top Performers on Key Quality Measures™ program recognizes accredited hospitals that attain excellence on accountability measure performance. The program is based on data reported about evidence-based clinical processes that are shown to be the best treatments for certain conditions, including heart attack, heart failure, pneumonia, surgical care, children's asthma, inpatient psychiatric services, stroke and venous thromboembolism."

Leapfrog Group

"On behalf of purchasers and employers across the country, The Leapfrog Group aims to: Inform Americans about their hospital safety and quality, promote full public disclosure of hospital performance information, help employers provide the best healthcare benefits to their employees."

U.S. News Best Hospitals Rankings

Best Hospitals 2012-13: "U.S. News surveyed nearly 10,000 specialists and sifted through data for approximately 5,000 hospitals to rank the best 16 adult specialties, from cancer to urology. Death rates, patient safety, and hospital reputation were a few of the factors considered."

Why Not The

" was created and is maintained by The Commonwealth Fund, a private foundation working toward a high performance health system. It is a free resource for health care professionals interested in tracking performance on various measures of health care quality. It enables organizations to compare their performance against that of peer organizations, against a range of benchmarks, and over time."


We believe that focused efforts on complete and accurate medical record documentation, quality improvements efforts and understanding what is being publicly reported about your efforts are positive steps towards clients embracing the shift in health care away from the traditional Fee-for-Service model towards payment for Quality Care as evidenced by current initiatives such as the 30 Day Readmission Reduction Program, Value-Based Purchasing and Accountable Care Organizations.

Article Author:

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.